A three month course of low-dose azithromycin may protect people hospitalised with a severe acute exacerbation of COPD from recurrent attacks, a European trial suggests.
The macrolide antibiotic may offer a targeted prevention approach for COPD patients by reducing treatment failure and rehospitalisation in the high-risk period following an acute severe exacerbation, according to Belgian researchers.
In a double blind prospective trial involving 301 patients they randomised patients to azithromycin or placebo within 48 hours of being admitted for an exacerbation, in addition to the standard medicine such as corticosteroids.
Patients in the azithromycin arm of the study received 500mg/day for three days while hospitalised, and then 250 mg twice weekly for three months once they left the hospital.
At three months, treatment failure, defined as treatment intensification with medication, step-up in hospital care or readmission for respiratory reasons (SH) occurred in 49% of patients those in the azithromycin group vs. 60% in the placebo arm.
Those receiving the antibiotic spent 24% fewer days in the hospital and 74% fewer days in the ICU than those taking the placebo. Mortality among those in the azithromycin group was half of the placebo group: 2% vs. 4%.
However the primary endpoint of time to treatment failure did not reach statistical significance in differences between groups. Subsequent follow up showed that the clinical benefits of the azithromycin were no longer evident at six months